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ScienceDirect

journal homepage: www.intl.elsevierhealth.com/journals/dema

Wear of polyetherketoneketones — Influence of

titanium dioxide content and antagonistic material

Thomas Kewekordes, Sebastian Wille ∗ , Matthias Kern

Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry,
Christian-Albrechts-University, Kiel, Germany

a r t i c l e i n f o a b s t r a c t

Article history: Objective. The aim of this laboratory study was to analyze the influence of titanium dioxide
Received 17 July 2017 (TiO2 ) content and antagonistic material on the wear of polyetherketoneketones (PEKKs).
Received in revised form Methods. Twenty-four disk-shaped specimens of two PEKK materials containing either
18 December 2017 10 wt% or 20 wt% TiO2 particles (P10 and P20) were dynamically loaded in a chewing simula-
Accepted 21 December 2017 tor with 49 N and additional thermal cycling (5–55 ◦ C). Subgroups of 8 specimens each were
Available online xxx loaded with spherical antagonists made from either steatite ceramic (St), zirconia (Zr), or
the same PEKK material (P10 or P20). After 120,000, 240,000, 480,000, 840,000, and 1,200,000
Keywords: loading cycles the vertical substance loss and the volume loss of the loaded specimens
PEKK were evaluated using a laser scanner. Data were checked considering the normal distribu-
Chewing simulator tion (Shapiro–Wilk test) and were inspected for significant differences by means of single
Wear factor variance analyses and post hoc pair comparison (Games-Howell test).
TiO2 Results. After 1,200,000 chewing cycles, statistical analyses revealed a significant influence of
Laser scanning microscope the antagonistic material. A significant difference was also found between the tested PEKKs
Thermal cycling if Zr was used as the antagonist. The volume loss ranged from between 0.073 mm3 (P20-P20)
and 0.228 mm3 (P10-St), and the vertical substance loss ranged between 73.71 ␮m (P20-P20)
and 115.268 ␮m (P10-Zr).
Significance. The inclusion of TiO2 particles influences the wear behavior of PEKK materials.
© 2018 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

corrosion can result in a metallic taste and pain [4]. More-

1. Introduction over corrosion products can cause diseases such as gingivitis,
lichenoid reactions or mucosal necrosis [5].
Because of the constantly increasing demands of patients for
Ceramics in dentistry have – in addition to positive
aesthetic and high-quality dental restorations, metals have
characteristics such as good biocompatibility [6], natural
been replaced as dental restoratives by ceramics and polymers
appearance [7], low plaque accumulation [8] and high com-
[1]. The corrosion of metals can increase surface roughness
pressive strength [2] – the disadvantages of lower bending
that could serve as retention sites for plaque [2,3], and galvanic
and tensile strength than metals [9]. Their brittleness is

∗
Corresponding author at: Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts
University, Arnold-Heller-Straße 16, D-24105 Kiel, Germany.
E-mail addresses: thomas.kewekordes@gmx.de (T. Kewekordes), swille@proth.uni-kiel.de (S. Wille), mkern@proth.uni-kiel.de (M.
Kern).
https://doi.org/10.1016/j.dental.2017.12.009
0109-5641/© 2018 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Kewekordes T, et al. Wear of polyetherketoneketones — Influence of titanium dioxide content and antagonistic
material. Dent Mater (2018), https://doi.org/10.1016/j.dental.2017.12.009
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Fig. 1 – Chemical structures of PEKK and PEEK.

responsible for spontaneous fractures or chipping when the

Table 1 – Group codes of the tested material
strength of the ceramic is exceeded [10]. Also, ceramics are combinations.
sensitive to processing and application errors [11]. As an alter-
Group code Tested material Antagonistic material
native to ceramics, the indications for polymers in dentistry
have expanded in recent years. The thermoplastic polymers, P10-St PEKK + 10 wt% TiO2 Steatite
P20-St PEKK + 20 wt% TiO2 Steatite
polyetheretherketones (PEEKs) have long been used in ortho-
P10-P10 PEKK + 10 wt% TiO2 PEKK + 10 wt% TiO2
pedics and traumatology as a substitute for metal components
P20-P20 PEKK + 20 wt% TiO2 PEKK + 20 wt% TiO2
because of their positive material characteristics [12]. In den- P10-Zr PEKK + 10 wt% TiO2 Zirconia
tistry, PEEKs have been used as materials for removable P20-Zr PEKK + 20 wt% TiO2 Zirconia
dentures and implant superstructures [13]. In an in vitro study,
the accumulation of biofilm was lower on implant abutments
2. Materials and methods
made of PEEKs than on those made of zirconium dioxide or
titanium [14]. Furthermore, a maxillary obturator prosthesis
2.1. Sample preparation
made of PEEK was reported to have good mucosal reactions in
areas where the mucosa was in contact with the denture [15].
Two PEKKs with a different portion of TiO2 particles were
PEKKs are also thermoplastic polymers with good biocompati-
investigated. The percentages of TiO2 were 10 wt% (Pekkton
bility [16,17] and improved chemical and mechanical qualities
ivory, Cendres + Métaux, Biel, Switzerland) and 20 wt% (Pekk-
because of the additional ketone group [18]. In addition, Moore
ton pearl, Cendres + Métaux, Biel, Switzerland). The size of the
et al. found in a rat study that PEKKs had a lower inflammatory
TiO2 particles was in the micrometer range. The specimens
response than polymethylmethacrylates [19].
were manufactured by milling technology (VhF, Ammerbuch,
Attrition and abrasion are important phenomena in the
Germany). The shape of the examined PEKK-specimens was a
wear of restorative materials [20]. The wear of natural teeth is
flat, oval plate with a width of 8 mm and a length of 11 mm.
to a certain degree a physiological process and should not be
The specimens were polymerized into metal sleeves with den-
disrupted by dental restorations. Ideally, the wear of enamel
ture acrylic resin (ProBase cold, Ivoclar Vivadent, Ellwangen,
in contact with restorative materials should not exceed the
Germany). These were clamped in special holders for the
physiological wear [21] of about 20 ␮m–40 ␮m per year [22]. If
chewing simulator. Afterwards, the specimens were ground
restorative materials have a wear behavior that differs from
under water cooling with rotating silicon carbide paper (600
natural tooth structure, the wear of the antagonistic natu-
grit) and polished (2500 grit silicon carbide paper).
ral teeth might be affected [23]. Therefore, an ideal dental
restorative material should replicate the wear behavior of nat-
2.2. Wear measurements
ural tooth structure. Reduced wear of the occlusal surface of
artificial dentures can lead to extended strain on antagonist
Twenty-four specimens of each investigated material were
teeth and their periodontium that may result in periodontal
loaded into a chewing simulator (Chewing Simulator CS-
or functional problems due to occlusal interferences [24–26].
4, SD Mechatronic, Feldkirchen-Westerham, Germany). The
Both PEKK and PEEK belong to the polyaryletherketone
specimens were randomly allocated to three subgroups with
(PAEK) family and are thermoplastic resins. The chemical
different antagonists. Six-mm diameter balls of St (Hoechst
structure of all PAEKs is based on the same aromatic rings
Ceram Tec, Wunsiedel, Germany), Zr (BCE Special Ceramics
and differs according to their ratio of keto- and ether-groups
GmbH, Mannheim, Germany) and PEKK (Cendres + Métaux,
(Fig. 1). According to the manufacturerı́s specification, the
Biel, Switzerland) (n = 8 each group) were used as the antago-
physical characteristics of PEKKs can be similar to those of
nists to simulate physiologic occlusal point contacts (Table 1).
dentin, and oxide particles can influence the mechanical char-
Table 2 shows the materials used.
acteristics and the color of PEKK materials (Cendres + Métaux,
The antagonistic balls were attached in special holders
Biel, Switzerland). PEKK materials have been successfully used
with modeling resin (Pattern Resin, GC Europe N.V., Leu-
for implanted prostheses [27–29].
ven, Belgium). Before each test series, impressions of the
The aim of this study was to evaluate the influence on wear
surfaces of the unloaded specimens were made with low-
against different antagonistic materials of two TiO2 concentra-
viscosity silicone (Express 2 Ultra-Light Body Quick, 3 M, St.
tions in PEKK.
Paul/Minnesota, USA). Afterwards, the specimens were each
The null hypothesis of this study was that no different
loaded dynamically with the parameters presented in Table 3
wear behavior would be found for P10 and P20 loaded with
in the chewing simulator with thermal cycling (5–55 ◦ C) and a
antagonists made from St, Zr, or the same PEKK material.
loading force of 49 N. After 120,000, 240,000, 480,000, 840,000

Please cite this article in press as: Kewekordes T, et al. Wear of polyetherketoneketones — Influence of titanium dioxide content and antagonistic
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Table 2 – Lot numbers of the used materials.

Pekkton pearl specimens Cendres + Métaux, Biel, Switzerland LOT X0223-2118m-AL-04
Pekkton ivory specimens Cendres + Métaux, Biel, Switzerland LOT 000230666
Pekkton pearl balls Cendres + Métaux, Biel, Switzerland LOT X0223-2118m-AL-04
Pekkton ivory balls Cendres + Métaux, Biel, Switzerland LOT 181265
Zirconia balls BCE Special Ceramics GmbH, Mannheim, Germany LOT 10.07.09/07
Express 2Ultra-Light Body Quick 3 M, St. Paul/Minnesota, USA LOT 523987
Steatite ceramic balls Hoechst Ceram Tec, Wunsiedel, Germany

Table 3 – Test parameters of the chewing simulation. 3. Results

Cold/hot bath temperature 5 ◦ C/55 ◦ C
Vertical movement 6 mm The mean volume and the vertical substance loss of the spec-
Rising speed 55 mm/s imens, the standard deviation after different chewing cycles
Descending speed 30 mm/s
and the results of pair-wise comparisons of the means are
Weight per specimen 49 N
summarized in Tables 4 and 5. The progress of the volume
Kinetic energy 2250 × 10 − 6 J
Dwell time 60 s and vertical substance loss of the two tested PEKKs are shown
Horizontal movement 0.3 mm in Figs. 2 and 3. After 1,200,000 cycles, the mean volume
Forward speed 30 mm/s loss ranged from 0.073 mm3 (P20-P20) to 0.228 mm3 (P10-St)
Backward speed 50 mm/s and the vertical substance loss ranged from 73.7 ␮m (P20-
Cycle frequency 1.3 Hz P20) to 115.2 ␮m (P10-Zr). The Shapiro–Wilk-Test revealed only
occasionally significant deviations of the normal distribu-
and 1,200,000 chewing cycles, the vertical substance loss and
tion so that an analysis of variance was used for statistical
the volume loss of the loaded specimens were evaluated.
analysis, which is robust against slight deviations of nor-
The specimens were cleaned with oil-free compressed air,
mal distribution [30]. The 1-way ANOVA evaluated to what
and impressions (Express 2 Ultra-Light Body Quick, 3 M, St.
extent significant effects appeared between the different com-
Paul/Minnesota, USA) were made after corresponding chewing
binations of material after 120,000, 240,000, 480,000, 840,000
cycles. For this purpose the cartridge filled with low-viscosity
and 1,200,000 chewing cycles. Significant effects among all
silicone was inserted into the dispenser. After discharging a
six groups for both loss of volume and vertical substance
low amount of silicone, it was slowly put on the edge of the
were found after all chewing cycles (ANOVA, p ≤ 0.05). Testing
specimens under permanent material contact until the entire
the homogeneity of variance of the different combinations of
specimen was covered with silicone. At this point the spec-
material showed that these were not homogeneous (Levene
imens were left behind in the chewing simulator to avoid
Test, p ≤ 0.001), so subsequently post hoc-pair comparisons
an incorrect position afterwards. A timer was set to 5 min to
via the Games-Howell-Test were made to test single material
prevent underrunning the setting time of the silicone. After
combinations for significant differences in each case. This test
5 min the silicon impressions of the specimens were carefully
revealed a significant difference between the material com-
removed and sorted into labeled boxes in the same order as
binations P10-Zr and P20-Zr (p = 0.036) in volume loss after
the measuring chambers. In the following the specimens were
1,200,000 chewing cycles. Furthermore, after 1,200,000 chew-
fixed with high viscosity silicone to be in a defined position
ing cycles, significant differences were indicated between the
for the process with the laser scanning microscope VK-x 100
material combination P10-Zr and P10-P10 (p = 0.042), between
(Keyence, Neu-Isenburg, Germany). All impressions were mea-
P20-St and P20-Zr (p = 0.025) and between P20-St and P20-P20
sured three-dimensionally with a laser scanning microscope
(p = 0.016).
at ×10 magnification using a semiconductor laser with a wave-
The vertical substance loss after 1,200,000 chewing cycles
length of 658 nm with an output power of 0.95 mW and pulse
with the material combination P10-Zr and P20-Zr (p = 0.026)
durations of 1 ns. The medium during the chewing simula-
and with the combination P20-St and P20-P20 (p = 0.032) were
tion was deionized water. The volume loss and the vertical
also significantly different. Vertical substance loss with the
substance loss were evaluated with the software VK-Analyse
material combination P10-P10 showed a large increase until
(Keyence). To investigate the influence of increasing roughness
480,000 chewing cycles when it remained almost constant.
of the specimens on the vertical substance loss, the Ra value
The roughness measurements of this group revealed an aver-
at the abraded surface and the initial Ra of the antagonists was
age roughness of Ra = 5.26 ␮m after 120,000 chewing cycles.
evaluated with the laser scanning microscope. Furthermore,
This value increased to Ra = 11.71 ␮m after 480,000 chewing
the Vickers hardness of P10 and P20 was measured with the
cycles and fell to Ra = 7.32 ␮m after 1,200,000 chewing cycles.
hardness tester 3212 Zwick with 2 kg load. For this purpose, 3
Roughness measurements of the other groups did not show
measurements were performed on 5 specimens each.
this behavior and are given in Table 7. Roughness measure-
ments of the antagonists revealed an average roughness of
2.3. Statistical analysis
Ra = 2.04 ␮m for Zr, Ra = 4.21 ␮m for St, Ra = 4.13 ␮m for P20
and Ra = 3.91 ␮m for P10. The Vickers hardness measurements
Data were evaluated for normal distribution with the
revealed an average hardness of 33.2 ± 1.5 HV 2 for P10 and
Shapiro–Wilk test followed by 1-way analysis of variance
32.1 ± 0.5 HV 2 for P20.
(ANOVA) and post hoc-pair comparison with the Games-
Howell test (SPSS 20.0).

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Table 4 – Mean volume loss and standard deviations of tested materials after various chewing cycles (in mm3 ; n = 8).
Same uppercase letters within a column show no statistically significant influence of the antagonistic material on the
wear of the tested PEKKs after the respective number of chewing cycles (p ≥ 0.05). Same lowercase letters within a row
show no statistically significant influence of the tested PEKKs on its volume loss after the respective number of chewing
cycles (p ≥ 0.05).
Cycles Antagonist Means of volume loss in mm3 Means of volume loss in mm3
and (standard deviation) of P10 and (standard deviation) of P20
120,000 St 0.018 (0.006)a A, a 0.049 (0.045) AB, a
Zr 0.011 (0.005) A, a 0.012 (0.003) A, a
PEKK 0.011 (0.004) A, a 0.006 (0.003) B, a

240,000 St 0.030 (0.010)a A, a 0.069 (0.061) A, a

Zr 0.029 (0.010) A, a 0.019 (0.003) A, a
PEKK 0.024 (0.005) A, a 0.012 (0.004) A, b

480,000 St 0.047 (0.017)a A, a 0.104 (0.070) AB, a

Zr 0.059 (0.021) A, a 0.039 (0.007) A, a
PEKK 0.041 (0.011) A, a 0.024 (0.006) B, a

840,000 St 0.106 (0.069)a AB, a 0.151 (0.072) A, a

Zr 0.131 (0.040) A, a 0.061 (0.010) A, b
PEKK 0.061 (0.018) B, a 0.049 (0.009) A, a

1,200,000 St 0.228 (0.156)a AB, a 0.212 (0.077) A, a

Zr 0.181 (0.063) A, a 0.085 (0.010) B, b
PEKK 0.087 (0.030) B, a 0.073 (0.012) B, a
a
Because of incorrect measurements, one specimen was excluded (n = 7).

Table 5 – Mean vertical substance loss and standard deviations of tested materials after various chewing cycles (in ␮m;
n = 8). Same uppercase letters within a column show no statistically significant influence of the antagonistic material on
the wear of the tested PEKKs after the respective number of chewing cycles (p ≥ 0.05). Same lowercase letters within a
row show no statistically significant influence of the tested PEKKs on its vertical substance loss after the respective
number of chewing cycles (p ≥ 0.05).
Cycles Antagonist Means of vertical substance loss in Means of vertical substance loss in
␮m and (standard deviation) of P10 ␮m and (standard deviation) of P20
120,000 St 25.740 (5.2)a A, a 36.838 (26.3) A, a
Zr 20.920 (4.5) A, a 18.772 (4.0) A, a
PEKK 19.274 (12.7) A, a 15.877 (4.1) A, a

240,000 St 32.584 (6.4)a A, a 46.580 (27.8) AB, a

Zr 39.030 (9.2) A, a 30.156 (4.4) A, a
PEKK 67.731 (30.9) A, a 21.605 (4.3) B, b

480,000 St 46.169 (8.1)a A, a 63.311 (25.8) A, a

Zr 57.903 (11.5) A, a 44.981 (5.5) A, a
PEKK 88.061 (42.4) A, a 34.933 (7.1) A, a

840,000 St 74.284 (32.8)a A, a 84.637 (25.3) A, a

Zr 94.191 (18.2) A, a 57.128 (4.5) A, b
PEKK 78.434 (28.7) A, a 51.326 (10.2) A, a

1,200,000 St 113.173 (46.3)a A, a 107.164 (21.4) A, a

Zr 115.269 (21.6) A, a 82.983 (7.9) AB, b
PEKK 85.306 (22.1) A, a 73.710 (7.6) B, a
a
Because of incorrect measurements, one specimen was excluded (n = 7).

Heintze et al. noted no major difference in the quantifi-

4. Discussion cation of substance loss by chewing simulations whether
measured by 3D laser scanning, with a mechanic sensor or
In this laboratory study, the two-body wear of two PEKKs
with an optic sensor [37]. However, in this study, the assump-
was tested in a chewing simulator with different antagonistic
tion was that volume loss of the tested specimens was more
materials. Different in vitro wear tests have been reported, par-
informative than vertical substance loss, because in the mea-
ticularly two-body wear [31,32] and three-body wear [33,34].
surement of height loss, singular peaks have a stronger impact
Three-body simulators use abrasive slurry, added between the
on the results of measurement by laser. About 240,000–250,000
antagonistic material [35,36]. For this study, two-body wear, in
chewing cycles simulate approximately one year in vivo;
which only specimen and antagonist were used, was chosen
therefore, 5 years were simulated in the present study [38–40].
to allow comparisons with other studies.

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Fig. 2 – Volume loss of P10 und P20 after 120,000, 240,000, 480,000, 840,000 and 1,200,000 chewing cycles in mm3 .

120

100

80 P20-St
P10-St
60 P20-Zr
P10-Zr
40

20

0
0 240000 480000 720000 960000 1200000

Fig. 3 – Vertical substance loss of P10 und P20 after 120,000, 240,000, 480,000, 840,000 and 1,200,000 chewing cycles in ␮m.

Table 6 – Comparison of enamel wear studies after various chewing cycles in the chewing simulator.
Study Cycles Loading force Specimen/antagonist Wear
Burgess et al. [48] 100,000 10 N Enamel/enamel 0.17 mm3
200,000 10 N 0.27 mm3

Mehl et al. [43] 120,000 49 N Enamel/steatite 0.015 mm3

240,000 49 N 0.017 mm3
480,000 49 N 0.022 mm3
840,000 49 N 0.029 mm3
1,200,000 49 N 0.037 mm3

Ghazal et al. [49] 120,000 49 N Enamel/steatite 38 ␮m

240,000 49 N 41 ␮m
480,000 49 N 46 ␮m
840,000 49 N 53 ␮m
1,200,000 49 N 56 ␮m

Kern et al. [40] 120,000 49 N Enamel/steatite 0.022 mm3

240,000 49 N 0.029 mm3
480,000 49 N 0.045 mm3
840,000 49 N 0.067 mm3
1,200,000 49 N 0.083 mm3

Jung et al. [50] 240,000 49 N Feldspathic 0.119 mm3

240,000 49 N Porcelaina /enamel zirconiab /enamel 0.031 mm3

Kim et al. [51] 300,000 49 N Zirconiab /enamel feldspathic 0.04 mm3

300,000 49 N Porcelaina /enamel heat-pressed 0.11 mm3
300,000 49 N Ceramicc /enamel 0.06 mm3
a ®
Vita Omega 900 (Vita Zahnfabrik, Bad Säckingen, Germany).
b ®
Zirkonzahn prettau (Zirkonzahn GmbH, Bruneck, Italy).
c
IPS e.max Press (Ivoclar Vivadent, Liechtenstein).

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Table 7 – Mean roughness measurements (Ra ) in ␮m of the material combinations.
Cycles P10-St P20-St
120,000 3.398 3.721a
240,000 3.654 3.439a
480,000 4.291 3.584a
840,000 3.890 3.895a
1,200,000 3.655 4.077a
a
Because of incorrect measurements, one specimen was excluded (n = 7).
In a clinical study, Lambrechts et al. reported the wear rate
of enamel after 12 months as 51 ␮m for molars and 32 ␮m for
premolars. After 48 months, the molar wear rate was 153 ␮m
and the premolar wear rate was 88 ␮m [41]. The vertical sub-
stance loss after 840,000 chewing cycles (corresponding to 48
months) in the present study (51 to 94 ␮m) was similar to that
of the clinical study. However, the comparison of in vivo and
laboratory data is meaningful only to a limited extent because
the wear of natural teeth depends on more factors than just
antagonistic contacts [42]. In the interest of comparability of
the obtained data, Table 6 presents various wear tests with
natural enamel in different chewing simulations. By compar-
ing laboratory studies of the average dental enamel wear with
the test results, the wear of dental enamel was significantly
lower than that of the tested PEKKs (volume loss and vertical
substance loss) after 1,200,000 chewing cycles. However, when
the wear of the tested PEKK materials was compared with
that of six dental composites with steatite as the antagonis-
tic material [43], the wear seemed to be of similar dimension
(Tables 4 and 5 compared with Table 6).
It was assumed that the different amounts of TiO2 par-
ticles of the tested PEKKs resulted in a different hardness,
and therefore the wear resistance increased. However, these
characteristics had no significant effect on wear except when
Zr was the antagonist. The increased wt% of TiO2 particles
increased wear resistance only for antagonist materials with
low roughness. The total loss of substance depends on the
hardness of the materials involved, the geometry of the par-
ticles involved, and the load and length of the contact area
[44]. The load and the contact area were constant parame-
ters in the chewing simulation. As reported, the roughness of
the Zr antagonists was significantly less than the roughness
of all other antagonistic materials. The Vickers hardness of
the antagonists used was about 680 MPa for St [45], 1300 MPa
for Zr (BCE Special Ceramics GmbH, Mannheim, Germany),
and 252 MPa for P10 (Cendres + Métaux, Biel, Switzerland).
According to the corresponding manufactures the compres-
sive strength is 830 MPa for St, 2200 MPa for Zr and 246 MPa
for P10 and the elastic modulus is 80 GPa for St, 200 GPa for Zr
and 5.1 GPa for P10. According to the manufacturer the values
for the compressive strength and elastic modulus for P20 are
similar to those of P10.
The wear of the two tested PEKK materials with differ-
ent amounts of TiO2 particles against the St and the PEKK
antagonists was not significantly different (p > 0.05). It appears
that the TiO2 particles were removed from the bulk mate-
rial with the polymer matrix material by the rougher St and
PEKK antagonists. Therefore, the hard ceramic pigments did
not affect wear resistance against these antagonists. How-
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P10-Zr P20-Zr P10-P10 P20-P20
4.559 3.764 5.260 4.311
4.450 3.999 10.240 4.234
4.605 3.704 11.714 5.878
4.552 3.907 8.535 6.287
4.107 4.901 7.321 6.042
ever, the roughness of Zr antagonists was lower. This might
be why the number of particles in the micrometer range sig-
nificantly influences the wear resistance of the PEKK. The
lowest wear occurred when the PEKKs were tested against
themselves. In this case, the wear compared well with the
wear of natural enamel and St as antagonist. This effect of a
lower hardness antagonistic material is well known [44]. Ver-
tical substance loss with the material combination P10-P10
showed a large increase up to 480,000 chewing cycles, after
which it remained almost constant. This could be attributed
to an initial increase in roughness and subsequent leveling
(Fig. 3) as confirmed by roughness measurements. It might be
that due to the lower portion of TiO2 particles in P10 compared
to P20, during the chewing simulation some polymer matrix
is initially retained. Therefore, in contrast to P20 the mate-
rial is not homogeneously worn off, as the polymer matrix is
not completely removed with the TiO2 particles. In addition,
statistical analysis revealed significant differences regarding
the volume loss between P20-St and P20-Zr and also between
P20-St and P20-P20 but no significant difference between P20-
P20 and P20-Zr. The significant variations between P20-St and
P20-Zr were due to the varying roughness of the antagonists St
and Zr. In the case of P20-St and P20-P20, the significant con-
trast was caused by the different hardness of the antagonists.
The tests showed no significant differences between P20-P20
and P20-Zr. The higher roughness of the antagonist P20 may
have been compensated for by the higher hardness of Zr. How-
ever, regarding P10, significant differences were only found
between the antagonists Zr and P10 visible. In this case, the
higher hardness of the antagonist Zr does not seem to corre-
late with the higher roughness of the tested PEKK. Wear is not
a material property but a system property, so material strength
may play a role. However, relation of the values for the mate-
rial strength of the tested materials is similar to the relation of
the values for the hardness of these materials. This may lead
to an increase of the influence of the material. The use of St
as antagonist caused nonsignificant differences between P10
and both the other antagonists because of its high standard
deviation.
A limitation of this study is that it is a laboratory study.
Its conditions only simulate the clinical situation to a lim-
ited extend, so the clinical behavior might differ from the test
results. Another limitation is that the only tested parame-
ter was wear. Furthermore, it has to be considered that flat
specimens, probably due to the higher stress distribution in
the specimens [46], show higher material loss than anatomi-
cally shaped crowns [47]. In summary, the wear of the tested
PEKKs was higher than that of comparable studies with natu-
ral enamel but comparable with current restorative materials.
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An appropriate comparison of the results of this study with
the values determined in the vivo study by Lambrechts et al.
is not possible. Using the approach of several test parame-
ters, for example, different chewing forces and a three-body
wear simulation with various abrasive slurries, could improve
comparability with the natural masticatory apparatus.
The null hypothesis was accepted after 1,200,000 chewing
cycles using St or the same PEKK as the antagonistic mate-
rial. Neither volume loss nor vertical substance loss showed
significantly different values. However, a statistically signifi-
cant difference was found between PEKK and Zr, so the null
hypothesis was rejected for Zr as the antagonistic material.
5. Conclusion
Within the limitations of this in vitro study, the following con-
clusions were drawn:
1. Depending on the antagonist roughness. the amount of
TiO2 particles had a significant influence on the wear
behavior of PEKKs.
2. Wear of the tested PEKKs with St as the antagonist was
comparable with wear of dental composites but not with
wear of dental enamel.
3. Against Zr or the same PEKK as the antagonist, the amount
of wear was comparable to the amount of wear of dental
enamel against St.
4. Wear of the tested PEKKs against themselves showed the
lowest rates in this study.
Acknowledgements
The authors wish to thank Frank Lehmann and Rüdiger Möller
(Department of Prosthodontics, Propaedeutics and Dental
Materials, School of Dentistry, Christian-Albrechts-University
at Kiel) for technical support and Ulrike von Hehn and Jür-
® potential of particulates derived from two composite
gen Hedderich (Medistat , Kiel) for statistical advice. This
study was supported financially and with materials by Cen-
dres + Métaux SA (Biel, Switzerland).
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